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Full text of "Navy Department BUMED News Letter Vol. 5, No. 4, February 16, 1945"

Vol. 5 Friday, February 16, 1945 No. 4 



TART iK OF CONTENTS 

Japanese "B" Encephalitis 1 Lues: Chemotherapeutic Synergism. 14 

Flashburn Cream 6 Surgery in Forward Areas 15 

Burns from Rocket Blasts 6 Field Laboratory, Camp Lejeune ...18 

Epidemic Hepatitis: Gamma Globulin.. 7 Medical Officers: Combat Duties.... 20 

Diphtheria: Prevention and Control ....8 Alcoholism: Loss of Pay .20 

New Trypanocidal Agent 10 Combat Medical Planning Branch. . . .22 

Peripheral Nerve Injuries 11 Erratum: Plague ....22 

Virus Pneumonia: Transmission 12 Virginia Medical College 32 

Physical Fitness in Aviators 13 Public Health Foreign Reports 23 



Form Letter : 

Identification of BuMed Forms and Publications BuMed 24 

****** 

Tapanese <f B" Encephalitis : This disease is caused by a virus which i n 
many respects resembles the etiologic agent of St. Louis encephalitis. The 
first major outbreak of Japanese "B" encephalitis was reported from Japan 
in 1924. During that year 6,125 cases occurred. Review of cases from pre- 
vious years shows that the disease has been prevalent since the beginning of 
the century and perhaps occurred in the last century. In Japan 21,355 cases, 
with 12,159 deaths, were reported between 1924 and 1937. The greatest inci- 
dence is in the three prefectures lying on the coast of the Inland Sea. Small 
outbreaks or sporadic cases have appeared also in Formosa, the southern 
Ryukyu Islands, eastern China and eastern U.S.S.R. Case fatality rates have 
ranged from 42 to 75 per cent, averaging about 60 per cent. However, in men 



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of military age the rate should be considerably lower, as the disease is much 
more likely to be fatal in the very young and the old. The disease affects 
all ages, but morbidity tables for different age groups show an increase 
with advance in years. There is no correlation between morbidity rate and 
density of population. By far the greatest .incidence is in the months of 
August and September. An increase in the number of cases frequently fol- 
lows a period of little rainfall. 

The virus of Japanese "B" encephalitis probably has its reservoirs in 
mammals and birds. Studies of the mode of transmission strongly suggest 
that the disease is mosquito-borne. Several species of mosquitoes have 
been shown to be potential vectors. The virus has been isolated from Culex 
pipiens var. pallens and Culex tritaeniorhynchus collected in the areas of 
epidemicity by Japanese and Russian investigators. Both these culicine 
species as well as Aedes togoi Theobald, Aedes albopictus and Aedes 
japonicus Theobald are capable of transmitting the disease to susceptible 
mice and monkeys in laboratory experiments. Hammon has demonstrated 
that six species (three genera) of mosquitoes found in California can trans- 
mit the virus of Japanese <£ B" encephalitis to animals and has demonstrated 
its presence in the blood of inoculated chickens. Once introduced into this 
country the disease might readily spread under the favorable conditions which 
exist in wide areas. 

Pathology: According to all available reports the pathology of Japanese 
"B" encephalitis is almost identical with that of St. Louis encephalitis and 
is very similar to that of the Western equine type. 

The neurotropic "B" virus on invading the human body first produces a 
generalized septicemia, then rapidly becomes localized in the central nervous 
system, particularly the cerebral lobes. At necropsy an acute non- suppurative 
inflammation of the central nervous system is found. The cerebrospinal fluid 
is increased in amount and is clear. There is usually severe vascular conges- 
tion with occasional petechial hemorrhages. A definite perivascular cuffing, 
confined largely to the Virchow-Robin spaces, is characteristic. Infiltration 
of the meninges and nerve tissues with mononuclear cells and degeneration 
of nerve cells are common. Definite areas of softening and regressive changes 
in the glial nodules are particularly characteristic of Japanese "B" encepha- 
litis, according to Japanese reports. The predominant cell taking part in the 
inflammatory process is the lymphocyte. Marked changes are frequently 
found in the lungs and kidneys In cases where death occurs 
five or more days after onset, it is commonly the result of bronchopneumonia 
or uremia. In such instances there is characteristic bronchopneumonic con- 
gestion of the lungs or acute swelling and congestion of the kidneys with hemor- 
rhagic pyelonephritis. 



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Clinical Picture ; The course of Japanese "B" encephalitis varies con- 
siderably among different individuals and in different age groups. While the 
disease may be mild and often symptomless in children and young adults, it 
is likely to be more severe when it occurs in infants and the aged and is in 
them attended by a higher mortality rate. 

The onset is usually sudden. It most frequently is characterized by head- 
ache, severe malaise, fever, backache, abdominal pains, nausea and vomiting. 
However, in some cases these general symptoms may be accompanied by im- 
mediate encephalitic manifestations, such as very severe headache, mild 
rigidity of the neck and back, mental confusion, tremors, speech difficulties 
and frank stupor. 

As previously mentioned, encephalitic symptoms commonly appear 
just before the peak of fever (second to fourth day of illness) . The 
temperature may reach 102° F. in mild cases or 105° to 106° F. in severe 
cases. At the height of the fever other neurological signs may develop. The 
pupils become small and respond poorly to light. Mild nystagmus 'or slight 
strabismus may be present. Tendon reflexes show transient and variable 
changes, and usually the abdominal reflexes cannot be obtained. Involvement 
of other portions of the central nervous system may occasionally produce a 
bizarre clinical picture. During the next few days the symptoms and signs 
often become more pronounced, and coma may develop. In a small percen- 
tage of cases there is retention of the urine. Perspiration is profuse through- 
out the period of high fever. 

Death may occur within the first two days owing to an overwhelming in- 
fection. It may take place after from five to seven days, in- which case it 
usually results from complications such as bronchopneumonia, uremia or 
severe secondary infection of the urinary tract. 

The prognosis varies depending on the severity of symptoms and the age 
of the patient. In cases which recover, improvement in the neurological 
features is usually noted as the temperature approaches normal, commonly from 
five to fourteen days after onset. In severe cases the sensorium may remain 
clouded for weeks, and convalescence may proceed very slowly. Only in in- 
fants and elderly individuals are permanent serious residual changes in the 
central nervous system at all frequent. 

Diagnosis: The diagnosis of Japanese "B" encephalitis may be estab- 
lished in a laboratory equipped to do virus studies by demonstrating an in- 
crease in antibody titer during the course of the illness. However , under 
combat conditions the clinician will have to make the diagnosis on the basis 
of the clinical picture, presence in an area where the disease is endemic 



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and a careful and complete examination of the cerebrospinal fluid. When 
laboratory confirmation of the diagnosis is desired, sterile serum should be 
sent to the Medical Officer in Command, Naval Medical Research Institute, 
Bethesda, Maryland. Samples of 10 c.c. each should be obtained during the 
first week, at the end of the second week and, if possible, at the end of the 
fourth or fifth week. Some cross -immunity exists among the various types 
of encephalitis, and antibodies protective against the virus of Japanese "B" 
encephalitis may be present in the serum of patients who have lived in locali- 
ties where epidemics of the other varieties have been experienced. There- 
fore, it is requested that with each sample the usual place of residence of the 
individual from whom it was obtained be sent. 

A slight to moderate increase in spinal fluid pressure occurs in most 
cases. The white-cell count of the cerebrospinal fluid varies from 25 to 500 
per cu. mm. Fifty per cent or more of the cells may be polymorphonuclear 
leucocytes during the early phase of the illness. Subsequently there is a 
gradual relative increase in the number of lymphocytes. The presence of 
from 5 to 15 per cent of large mononuclear cells after the first two to three 
days of illness is considered of diagnostic importance. Total protein and 
globulin are usually slightly increased. Glucose remains at normal levels. 
The smear is negative for bacteria. 

White blood cell counts are normal or slightly elevated with an increase 
in the polymorphonuclear cells. 

In making a diagnosis during the early acute stage numerous diseases 
must be differentiated from Japanese "B" encephalitis. Later, with the ap- 
pearance of definite typical encephalitic symptoms and signs, the diagnosis 
may be made without great difficulty. Some of the conditions which may be 
confused with "B" encephalitis are malaria, dengue, typhoid fever, heatstroke, 
influenza, syphilis, tuberculous meningitis, early purulent meningitis, polio- 
myelitis, lymphocytic choriomeningitis and post -infectious encephalitis. Nega- 
tive serological tests will eliminate syphilis, typhoid fever and lymphocytic 
choriomeningitis. Absence of Plasmodia on repeated thick and thin film ex- 
amination will eliminate malaria. In poliomyelitis the sensorium is usually 
clear. Meningitis may be differentiated on the basis of the changes in the 
spinal fluid. Differentiation between post-infectious and Japanese "B" en- 
cephalitis may pose a particularly difficult diagnostic problem. 

Treatment : Treatment, although symptomatic, will have an important 
bearing upon the mortality rate. The majority of deaths are due to complica- 
tions, principally bronchopneumonia. The prevention and proper treatment of 
complications, as well as adequate treatment of the encephalitis proper, are 
of utmost importance. Hospitalization should be prompt. Lumbar puncture 
should be performed frequently enough to maintain a normal spinal-fluid pressure. 



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Hypertonic glucose or concentrated serum albumin may be given intravenously 
in selected cases to reduce elevated cerebrospinal -fluid pressure. At least 
3,000 to 4,000 c.c. of fluid should be given daily, or sufficient to maintain a 
urinary output of 1,500 to 2,000 c.c. Oral administration of fluid may have 
to be supplemented by intravenous administration. In cases where the ill- 
ness is prolonged, attention should be given to maintaining nutrition, espe- 
cially with respect to protein. The type of diet and mode of administration 
should be adapted to the condition of the patient. Careful nursing is 
essential. Patients, particularly those who become sluggish, stuporous or 
comatose, must be turned in bed regularly to prevent hypostatic congestion 
of the lungs and pressure sores.. Care should be taken to keep the throats 
of stuporous or comatose patients free of mucus. Pulmonary and urinary- 
tract complications should be watched for closely and treated promptly. 
Sulfonamide or penicillin should be employed as indicated in secondary » 
infections. 

Prevention: The general principles of mosquito control should be ap- 
plied meticulously. All personnel should be instructed in the use of mosquito 
repellents, and the rules should be vigorously enforced. At the present time, 
too little is known regarding the possible existence of reservoir hosts to 
justify applying measures for extermination. 

In view of the fact that Japanese "B" encephalitis, can be transmitted by 
the mosquito, patients with this disease should be screened at least during the 
febrile stage. It is not known whether the disease can be transmitted by the 
respiratory route. However, it would seem reasonable to observe the pre- 
cautions usually maintained in the presence of communicable disease of the 
respiratory tract. 

A vaccine has been developed by Sabin in this country which will protect 
experimental animals. No reports of field trials are as yet available. Con- 
tracts have been let by the Navy for the manufacture of adequate amounts of 
this vaccine, and when sufficient stocks become available, shipments will be 
made to naval activities operating in areas where personnel are likely to be 
exposed to Japanese "B" encephalitis. It is stated that the Russians have 
produced a somewhat similar type of vaccine which has proved effective in 
controlling this disease in eastern U.S.S.R. 

Great care should be exercised to prevent introduction of the disease 
into this country through admission of infected persons or vectors. CPrev. 
Med. Div. & Prof. Div., BuMed - J. K. Curtis & F. A. Butler) 



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Flashburn Cream: Reports received from the Pacific indicate that 
there is an increase in the number of burn casualties resulting, in part at 
least, from failure to observe prescribed precautions. Protective clothing 
should be worn by all personnel whose duties involve the hazard of flashburn. 

To supplement, but not replace, flash-proof clothing, a flashburn oint- 
ment is available. (See Burned News Letter of June 23, '44.). This ointment 
is intended for the protection of the face, arms, neck and hands of men at 
battle stations. It offers a degree of protection about equal to that of flash- 
proof clothing. 

General distribution of the protective ointment is made through the naval 
medical supply depots to combat troops and vessels. Naval medical officers 
should submit requisitions for this item in quantities sufficient to supply the 
needs of their vessels or activities. 

The ointment is dispensed in two- ounce tubes and is listed in the Medical 
Supply Catalog as No. Sl-2366, Cream, Protective Flashburn, NMRI 70. 
Requisition should be made on NMSD #4. 

Calculation of the number of tubes needed should be based upon (a) the 
number of men to be supplied and (b) the number of compartments and first- 
aid kits to be supplied, in somewhat the manner that the needs for S-330 anti- 
vesicant ointment were estimated. 

The initial supply of the protective flashburn cream was dispensed i n 
jars. Jars on hand should be examined, and if the ointment contained in them 
is found to have dried out, replacement should be made with ointment of more 
recent issue contained in two-ounce tubes. 

****** 

V 

Burns Incident to the Use of Rocket Launchers; In view of the increas- 
ing use of rocket launchers, attention is called to the possibility of injury to 
the eyes and face of the firer if no protective gear is worn. 

The hazard to personnel from blast at the rear of the-launcher is well 
recognized. Especially with certain types of launchers the backward blast 
from the rocket as it leaves the launcher is considerable. This blast con- 
tains unburned ballistite in particles the velocity of which may be gr e at 
enough to cause penetration and laceration of the skin of the face and hands 
and more serious damage to the eyes. 

The blast from the rocket is more likely to produce injury when the 
temperature of the air is low. Thus at temperatures above 32° F. injuries 



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to unprotected firers are mild, but at lower temperatures they may be serious. 
Under any conditions there is danger of serious injury to unprotected eyes. 
Flashburns have occurred. The flash deflector screen affords partial but 
always inadequate protection. 

Goggles and gloves should always be worn. When the air temperature is 
low, and at all temperatures during the launching of rockets of older types, a 
cloth screen for protection of the face and neck should be used. (Report, Arm. 
Med. Res. Lab., U.S. Army Proj. No. T-4) 

The prevention and Attenuation of Infectious Hepatitis bv Gamma Globulin : 
Stokes and Neefe observed an extensive outbreak of epidemic hepatitis at 
a summer camp for boys and girls. By the end of the second week of the 
epidemic approximately 80 persons had developed hepatitis, and the appear- 
ance of new cases in the next two days suggested that the entire population 
of the camp had been or would be exposed to the causative agent and that 
many others of the group could be expected to develop the disease. 

Gamma globulin was injected intramuscularly into 53 of the 331 persons 
who at that time showed no evidence of the disease. Hepatitis occurred in 67 
per cent of the controls but in only 20.8 per cent of those injected. Of the 53 
persons receiving gamma globulin, not one developed visible icterus of the 
skin. However, three developed scleral icterus which persisted for only 
four, five and seven days respectively. The average duration of icterus in 
34 controls for whom complete data are available was 14.2 days. These 
observations suggest that the effect of gamma globulin in the three persons 
was an attenuation of the disease. 

The results, which are statistically significant, indicate that gamma 
globulin is capable of preventing or attenuating infectious hepatitis when 
administered to exposed persons during the incubation period of the disease. 
This effect is comparable to that observed with the use of gamma globulin 
in measles. Although the data suggest that the best results are obtained 
when the globulin is injected early in the incubation period, it seems possi- 
ble that, as in measles, it may also be of therapeutic value if given early in 
the preicteric stage of hepatitis. The results obtained in this epidemic are 
sufficiently encouraging to warrant further trials of gamma globulin in the 
control of future epidemics of this disease. This is especially desirable be- 
cause no other effective control measures have as yet been developed. 
(J. A.M. A., Jan. 20, '44) 

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Diph theria: Prevention and Control: The spread of diphtheria among the 
population of Western Europe is a matter of concern to the occupying forces 
and, to a lesser degree, to the Navy. Even before the war Germany had a 
rising diphtheria rate. Since 1939 the curve has ascended progressively, and 
126,913 cases were reported for the first twenty-three weeks of 1944. Adis- 
turbing rise in incidence has been noted also in France, Belgium, the Nether- 
lands and Norway. The high morbidity due to diphtheria may be attributed to 
a number of causes including concentration of population from rural areas into 
urban centers, overcrowding of homes, air-shelters and factories, general 
lowering of hygienic standards, failure to develop satisfactory mass- 
immunization programs, and decline of host resistance as a result of mal- 
nutrition. 

In recent years the Navy has not been confronted with a serious out- 
break among its personnel. The morbidity rate for diphtheria has declined, 
with only occasional interruption, for the past twenty-four years: At present 
some cases are being reported from the Pacific Area. A small epidemic oc- 
curred during the past summer at a naval training center where the recruits 
came from a northern population highly susceptible to diphtheria. No tropi- 
cal ulcers or wounds infected with virulent diphtherlae have been reported 
as occurring among naval personnel. 

Diphtheria is principally an air-borne disease but also is spread by 
direct contact and by contaminated food and drink, especially milk. Avail- 
able sanitary measures are usually adequate to prevent serious outbreaks 
in naval activities. When sporadic cases appear, control measures must be 
applied with meticulous care and with the close cooperation of all concerned 
until the outbreak has-been terminated. 

Early recognition of . cases is imperative, not only to provide for their 
proper treatment but also to effect strict isolation. To this end all person- 
nel exposed during an epidemic should be isolated and examined daily. Those 
reporting with colds and sore throats should be kept, if possible, in the sick 
bay where throat cultures should be taken and the cases inspected twice daily. 
Suspicious cases should be isolated and should receive a minimum of 20,000 
units of diphtheria antitoxin intramuscularly following a negative test for 
sensitivity to horse serum. A small dose given early in a suspected case is 
more effective than a large dose given in the later stages of this disease. All 
contacts- should be isolated for seven days following the last exposure and until 
cultures prove them not to be carriers. 



To detect carriers all exposed personnel should have throat cultures 
once or twice weekly during an epidemic. Carriers should be isolated until 
their strains are proved by animal inoculation to be nonpathogenic or until 



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two nose and two throat cultures taken at twenty-four hour intervals are nega- 
tive. Penicillin may be given in an attempt to eradicate the carrier state . 
Persistence of the carrier state may necessitate tonsillectomy. Sulfonamides 
have not proved useful. 

Isolation technic should be rigidly enforced. Concurrent disinfection of 
all discharges from patients and of all articles in contact with patients should 
be carried out by steam sterilization or other effective procedures. Thorough 
cleaning, airing and sunning of the room should take place after the patient 
is discharged. Patients clinically well should be discharged only after two 
or more nose and throat cultures, taken at twenty-four hour intervals, are 
negative or the organisms are proved to be avirulent. Cultures for discharge 
may be started on the ninth day after the onset of the infection. A virulence 
test should be made if practicable when positive throat cultures are obtained 
two weeks or longer after onset of the disease. When termination by culture 
is impracticable, cases may be discharged with a fair degree of safety four- 
teen days after the onset of the disease. 

Epidemiological studies should be undertaken to discover the source of 
infection and mode of transmission. Contact food handlers should be cultured 
and allowed to return to the galley only if found free of organisms. Milk 
should- be pasteurized and handled with great care to avoid contamination. 
The common drinking cup should be eliminated. An explosive outbreak is 
usually due to food-borne infection, while a slowly developing epidemic may 
be due to air-borne or contact infection. Increasing the space between bunks 
of personnel in sleeping quarters and avoidance of crowding are most helpful 
in controlling an epidemic. 

Immunization procedures during an epidemic are time-consuming and of 
limited value. However, it is important to ascertain the susceptibles in an 
exposed group. As many as 45 to 75 per cent of young adults may be shown 
by the Schick test to be susceptible. Immunization with diphtheria toxoid is 
advised for those with positive tests only if a very definite hazard is develop- 
ing. Since adults are frequently sensitive to toxoid, a preliminary dose of 
0.1 c.c. injected intracutaneously is recommended, followed in 48 hours by 
the first immunizing dose of 0.5 c.c, provided no contraindicating reaction 
has occurred. Two subsequent doses of 1.0 c.c. at three-week intervals are 
given to those not showing serious reactions. Reactors may be given suitably 
small doses, or, if a large group is under observation, may be excused from 
further inoculations, as the nonsusceptibles plus those immunized will usually 
afford a sufficient barrier to the spread of the epidemic. 

Passive immunity may be effected with diphtheria antitoxin in small 
groups of close contacts when circumstances make it necessary to hold an 
outbreak in abeyance for a brief time. Passive immunization with antitoxin 



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is not a procedure to be recommended in the usual type of outbreak for the 
following reasons: 

a. Numerous individuals are sensitive to horse serum. Following the in- 
jections others will be made sensitive. 

b. Serum- sickness develops in a number sufficient to interfere with mili- 
tary operations. 

c. Passive immunity lasts only from ten days to three weeks. 

d. There is no effect on carriers. When immunity fades new cases- may 
begin to reappear. 

e. Antitoxin injections preclude using toxoid for permanent immunization 
for several weeks because the antitoxin will neutralize the antigen of the 
toxoid. 

f. When an insufficient amount of antitoxin is given for pur- 
poses of immunization during the incubation period of diphtheria, the disease 
process continues, with resulting continued production of toxin and with little 
or no membrane in the throat. It is essential to administer sufficient anti- 
toxin to prevent the development of the clinical disease, and it is well to re- 
member that recovery from an attack of diphtheria is not necessarily followed 
by active immunity, especially if antitoxin, has been used therapeutically. 
(Prev. Med. Div., BuMed - J. K. Curtis) 

Making of Loeffler Slants: One of the difficulties often encountered in 
studying diphtheria in the field is making good Loeffler slants. The follow- 
ing method has been recommended by Lt. Comdr. Donald E. Young (MC),USNR: 

Material: (1) A ten-pound dental plaster container with flat sides and a 
large mouth; (2) standard Navy autoclave; (3) absorbent cotton. 

Method: (1) Place a slanted layer of absorbent cotton in the bottom of 
the plaster can. (2) Make Loeffler slants in the usual manner and place in 
can. (3) Seal can by inserting a sheet of paper under the lid. (Make certain 
that the can is airtight before placing in autoclave.) (4) Autoclave the slants 
30 minutes at a pressure of 15 pounds. (5) Close steam valve at end of 30 
minutes. (6) Do not open escape or vacuum valves. (7) When the steam 
pressure gauge registers zero, remove can from autoclave. 

5(c 3|e a|c % % sfc 

A New Trypanocidal Agent: According to a recent preliminary report 
by Eagle, y -(p-arsenosophenyl) -butyric acid appears to be an active trypano- 
cidal agent. This compound was first described in 1940, and early studies 



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demonstrated its effectiveness against trypanosomes both in vitro and in ex- 
perimentally-induced trypanosomiasis in animals. Of particular significance 
is the fact that it appears to be effective against so-called "arsenic -resistant" 
strains. 

A large-scale field trial was begun in Africa in the summer of 1944, and 
to date more than 200 patients have been treated. The results so far suggest 
that with>-(p-arsenosophenyl) -butyric acid it maybe possible to cure early 
cases of trypanosomiasis in humans within a period of two weeks, with reason- 
able freedom from toxic reactions. The results in late cases are not encourag 
ing. (Science, Jan. 19, '45) 

* * * * * * 

Notes on the Surgical Management of Peripheral N erve Injuries: The pri- 
mary objective in all nerve anastomoses is the accurate end-to-end suture of 
normal nerve tissue. The application of certain surgical principles has been 
of sufficient value to warrant emphasis. 

Bloodless field : The use of an Esmarch bandage and tourniquet is a dis- 
tinct advantage in all peripheral-nerve surgery. Dissection is simplified 
thereby, and trauma to tissues is reduced. A bloodless field can be continued 
for a second hour if the tourniquet be released and circulation re-established 
for a period of ten minutes at the end of the first hour. Operating time is re- 
duced to such an extent by this procedure that maintaining a bloodless field 
for a longer period is seldom necessary. 

" S" incision : This technic of plastic surgery is well adapted to peri- 
pheral-nerve surgery. It is important not to have any incision cross a flexion 
crease at a right angle. Failure to observe this rule has been followed by 
many disabling scar contractures at the wrist and elbow joints. 

The "S" incision forms two skin flaps which, when reflected, allow excel- 
lent exposure of a wide area. Forceful mechanical retraction can thereby be 
eliminated, and damage to many fine muscular nerve branches avoided. 

Adequate nerve re section : Damage to the nerve may be more extensive 
than is obvious by inspection of the neuroma. It is imperative that the nerve 
end be resected until normal nerve tissue be encountered, even though this 
may necessitate extensive dissection of the nerve trunk to obtain end-to-end 
suture without tension. Uniting fibrosed nerve ends is futile. 

Methods of anastomosis : The nature of the suture material is important. 
Fine tantalum wire or fine silk are very satisfactory. Catgut should never be 
used, as it causes severe local reaction in the nerve. 



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The use of tantalum foil to wrap the suture line has not proved to be of 
definite value. The material is difficult to handle and fragments easily. 

Nerve grafts: Homografts have been unsuccessful. To our knowledge 
there has been no case recorded in which motor power returned after the 
use of this type of nerve graft. Theoretically a very short graft might be 
successful, but there is no indication for the use of this method unless the 
defect is too long to be overcome by mobilization of the nerve. Long grafts 
invariably become fibrosed. 

Postoperative care : Early physiotherapy is essential. Care should be 
taken to avoid any limitation of motion of joints in the involved extremity. 

Continued splinting is contraindicated. It is customary to allow active 
use of the normal muscles during the day and to apply a protective splint at 
night. A foot-drop brace should be worn during the day by patients with 
peroneal nerve paralysis. (C. H. Shelden, Nav. Hosp., Bethesda, Md.) 

****** 

Transmission of Primary Atypical Pneumonia to Human Volunteers : In 
a recent study Dingle and his associates were able to produce experimental 
primary atypical pneumonia in six volunteer subjects by inoculation with spu- 
tum and throat washings from patients with this disease. 

Sputum and throat washings were collected in turn from these six patients 
and were inoculated into a second group of volunteers by spraying into the nose 
and throat. Respiratory illnesses having all of the characteristic features of 
primary atypical pneumonia developed in 3 of 12 men receiving inoculum which 
had been filtered. Similarly, three instances of pneumonia occurred among 
12 individuals inoculated with unfiltered material from the same source. The 
infection was thus carried serially through two successive groups of well 
persons. No cases of pneumonia developed in any of the 18 men who received 
inoculum which had been autoclaved. 

The incubation period in the experimental disease differed with the type 
of inoculum. Persons receiving filtered material developed symptoms of dis- 
ease between twelve and fourteen days after inoculation. The onset of illness 
in those inoculated with unfiltered material was approximately one week earlier. 

The results of this experiment thus demonstrate that bacteria-free fil- 
trates, presumably containing a virus, can induce primary atypical pneumonia 
in man. (From the Respiratory Diseases Commission- Laboratory, U.S. Army, 
Regional Hospital, Section 2, Fort Bragg, North Carolina.) 



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The Relationship between Physical Fitness and Success in Training of 
U. S. Naval Flight Students : A comparison was made between physical fitness 
and success in flying among 1,076 U. S. naval flight students. One thousand 
completed the intermediate stage of training and 76 failed at this stage for 
reasons of poor flight performance. 

All of. the students were originally selected for training only after pass- 
ing a careful examination designed to exclude anyone who did not meet pre- 
scribed physical and psychological standards. During the training course 
much attention was given to maintaining and improving the degree of physical 
fitness. 

Physical fitness was measured by means of the "pack" or "step" tests, 
and over -all athletic ability and physical conditioning by means of a series 
of tests and evaluations which were collectively referred to as the "complete' 
fitness test. In using the term "physical fitness", we have in mind the ability 
of the human organism to perform external work. It is nearly synonymous 
with muscular fitness and implies a state of health over and above the mere 
absence of significant bodily defects and disorders . 

The analysis of the physical-fitness-test scores yielded somewhat sur- 
prising results. The physical-fitness level of students entering pre- flight 
training, with few exceptions, was high. The level was raised during pre- 
flight and maintained during primary and intermediate training. 

Flight performance was measured by (1) the average grade in primary 
and in intermediate training, (2) the number of times a cadet, because of 
poor flight performance, came before an advisory board, and (3) failure to 
pass the intermediate training stage. 

. The necessity for achieving and maintaining a high level of physical fit- 
ness for the successful performance of hard work or strenuous sports is 
known to many persons by experience and has been proved by actual measure 
ment. However, flying does not involve strenuous physical exertion. The 
ability to learn to fly an airplane rests more on certain psychological attri- 
butes of the individual than it does on the ability to perform hard muscular 
work. Consequently, the relationship between physical fitness and success 
in learning to fly is part of the broader problem of the relationship between 
physical fitness on the one hand and various psychological factors such as 
judgment, ability to learn and to think quickly, motivation, morale, courage 
and mental stability on the other. Physical educators declare that such a 
relationship exists to an important degree, but offer little or nothing in the 
way of scientific evidence as proof. The same problem has interested psy- 
chologists and teachers. Attempts to study this relationship in school children 
have led to inconclusive results. As far as we can learn, there has never 
been a satisfactory demonstration of this relationship. 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 

The results of this study show that differences in physical fitness in the 
upper levels bear no relation to success in flight training. Unless it can be 
assumed that the lowest level of physical fitness of the subjects, in this series 
represents a critical point - and there is no evidence for this - then it must 
be assumed that a positive relationship could begin to appear only at a still 
lower level. Furthermore, with regard to certain indirect benefits of the 
athletic program such as improvement in coordination of movements, orienta- 
tion, self-sufficiency, and the like, there is no proof that these factors were 
operative. 

It must be pointed out that there may be remote benefits associated with 
the athletic program in flight training. Since it is desirable for naval avia- 
tors in combat theatres to be in a good state of physical fitness - for survival 
in emergency if for no other reason - the fact that they leave intermediate 
training i n a state of good physical fitness is of great benefit provided that 
it is properly maintained. However, from what we have learned of the activi- 
ties of naval aviators and considering their smaller opportunity for regular 
and intensive physical exercises, it may be assumed that high degrees of 
physical fitness are lost in the great majority of cases. If higher degrees . 
of physical fitness are thought to be necessary during operational duty, that 
is the place where training must be carried out because there may be little 
carry-over from earlier periods of training. 

Other benefits which are considered to be associated with the athletic 
program should be assessed by means of objective criteria insofar as possi- 
ble. (School of Av. Med., Pensacola - A. Graybiel & H. West). 

>fv ^fi ^ 5^ 

Synergistic Action of Penicillin and Maoharsen in Experimental Syphilis: 
Preliminary results in the treatment of experimental syphilis in rabbits indi- 
cate that "mapharsen and penicillin are not merely additive, but actually 
synergistic in their spirocheticidal action. Relatively small doses of maphar- 
sen effect a striking decrease in the minimal curative dose of penicillin, and 
permit cures with schedules which are otherwise wholly ineffective." 

"Experiments now in progress indicate that small doses of penicillin, 
analogous to those used in the treatment of gonorrhea, may greatly retard 
the development of a primary lesion in rabbits, and in some cases prevent 
its appearance. It is as yet unknown whether the infection is actually aborted 
in the latter case, or whether the disease is merely rendered asymptomatic. 
In either case, it seems clear that the routine use of penicillin in the treat- 
ment of gonorrhea may have undesirable effects on the manifestation of syphi- 
lis simultaneously acquired." (Progress Report #13, Eagle, Johns Hopkins 
Univ.; OEMcmr-215. CMR Bulletin #23) 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 



Surgery in the Mediterranean Theater : At a recent meeting of the Sub- 
committee on Infected Wounds and Burns of the National Research Council, 
surgical experiences in the Mediterranean theater were discussed by Col. E. 
D. Churchill, Surgical Consultant for that area. The following is an abstract 
of Colonel Churchill's remarks: ■ 

During the Tunisian campaign it was. recognized that the foundation stone 
of good treatment must be excellent surgery by the forward units. The type 
of work done at this point to a great extent determines the incidence of later 
serious complications and even the chance of survival. Therefore, the aim 
has been to keep well-trained young men at the forward stations. 

When adequate debridement is done by forward units, infection is not 
active; 75 to 95 per cent of wounds can be secondarily sutured at the base 
hospital on the fifth to the fourteenth day, and prompt healing can be obtained 
without the use of chemotherapy. A day or two after the patient's arrival at 
the base hospital, which corresponds usually to the fourth or fifth day after 
he has been wounded, his dressings are removed in the operating room, and 
the wound is secondarily sutured without local or general use of the sulfona- 
mides or penicillin. At one base hospital 13,552 soft -part wounds were so 
treated without loss of life or limb; no serious complications developed, and 
more than 90 per cent healed promptly. Failures to heal were referable to 
seasonal variations, problems of evacuation, and the teclmic of the surgeon 
who did the secondary sutures. The principles of plastic surgery must be 
applied with a view toward good function of the parts. To this end it is often 
necessary to close first the muscles, and perhaps the fascia where the latter 
is essential for support, and to delay suturing the skin until three or four 
days later. The type of suture material used is not important when good tech- 
nic is employed; many wounds may be closed with nonabsorbable suture s . 
Simple pressure dressing and immobilization of the part are essential steps 
after the wound is sutured. 

Not all wounds of the soft parts can be closed. Those with deep recesses, 
those which have had inadequate debridement, and those with extensive loss 
of tissue often cannot be sutured. 

From the viewpoint of surgical treatment the gravity of suppuration or 
sepsis is not determined so much by the types or quantities of bacteria pres- 
ent in the wound as by the nourishment available to the bacteria. It is obvious 
that devitalized tissue cannot be removed by penicillin, but must be excised 
by the forward surgeon. In the Mediterranean theater no effort was made to 
test the effectiveness of penicillin. It was immediately accepted as a useful 
adjunct, and the aim was to see how much could be done with it. The use of 
penicillin as an adjunct to surgery was defined as therapy rather than as pro- 
phylaxis. It must be recognized that gas gangrene may develop when penicillin 



r r 

Burned News Letter, Vol. 5, No. 4 RESTRICTED 



is being administered or that a staphylococcus infection of the knee may de- 
velop under penicillin therapy if the initial surgery were inadequate, particu- 
larly if foreign bodies were left in the joint. However even complicated 
wounds associated with compound fracture and nerve injury can b e second- 
arily closed with the aid of penicillin if the debridement by the forward units _ 
has been well done. The procedures used to accomplish secondary closure 
under these conditions are termed reparative surgery in contrast to the pre- 
ventive or prophylactic surgery done in the forward areas. The time phase 
of the reparative surgery is from the fourth to the fourteenth day. 

In the treatment of compound fractures it must be recognized that the 
goal is not to apply internal fixation. Neither is it to get skin closure. The 
real goal is to prevent the development of a sinus leading down to bone. One 
should aim to get some kind of closure of soft parts over the bone, and while 
there may be a defect that will later require coverage with a skin graft, it is 
important that the fracture remain closed from the exterior. 

Study of the bacterial flora of wounds as related to clinical infection has 
not been a part of practical surgical management. Routine bacteriological 
cultures are not practical; and to wait for detailed reports on differentiation 
would seriously delay secondary closure. This is shown by the fact that a 
competent bacteriologist and two technicians were occupied seven months in 
making a complete survey of the bacterial flora of 36 wounds, 27 of which 
were septic and nine contaminated; 214 strains of bacteria were obtained. 

It has been proved that careful observation of the gross surgical pathology 
of the wound gives a better working picture than bacteriologic studies . The 
identity of the organisms is only a reflection of the pabulum in the wounds, 
and the latter is more important than the organisms themselves. Penicillin 
therapy is limited, since it cannot affect the pabulum in the wound. Nor can 
penicillin neutralize exotoxins or prevent their formation, as Clostridia de- 
velop in retained blood clot or devitalized tissue. 

The chief value of penicillin is to prevent and arrest invasive infection. 
Parenteral administration is to be preferred. Sulfonamides likewise are use- 
ful in controlling invasive infection but are less effective than penicillin. Well 
debrided wounds do not need local chemotherapy. The adequacy of debridement 
is indicated by the appearance of the wound five days later. 

The use of chemotherapy in wound treatment may be summarized as fol- 
lows: 

1. Soft-part wounds, adequately debrided, dressed and splinted, can be 
sutured after four or five days without using chemotherapy. 



- 16 - 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



2. However, soft-part wounds with deep recesses and great muscle dam- 
age should have penicillin. 

3. Compound fractures need penicillin administered systemically. 

4. All cases in which reparative surgery is undertaken should have peni- 
cillin preoperatively and postoperatively. 

No antibacterial agent can remove all pathogenic bacteria from a wound, 
and in general the idea of sterilizing a wound is bad. Debridement must not 
be less thorough because penicillin is available. There is no substitute, for 
complete excision of devitalized tissue. 

Clinical management of wounds must be determined by their gross patho- 
logic appearance. Pus containing gram-negative organisms indicates the 
presence of dead tissue left by inadequate debridement. Repeated dressings 
should be unnecessary when all dead tissue is removed. 

Penicillin was used in a considerable number of compound fractures in 
a controlled study at two general hospitals. From the results it was decided 
that there was distinct advantage in using penicillin before, during and after 
reparative surgery on compound fractures in order to control invasive infec- 
tion. Penicillin was not employed locally except in the joints and in the pleural 
cavity. In connection with reparative- surgery, internal fixation was employed 
where it seemed distinctly indicated and advantageous, decision as to its use 
depending upon the judgment of experienced orthopedic surgeons rather than 
upon any fixed rule. 

In the treatment of compound injuries of the joints, especially the. knee, 
it was found advisable to explore penetrating wounds of the joint, to make 
certain that all foreign material was removed and to close the capsule, leaving 
penicillin in the joint. In cases seen at the base with penetrating wounds of 
the joint in which penicillin had been given without favorable response/it was 
found advisable to perform an arthrotomy, explore the joint, remove foreign 
material and dead tissue, fill the joint with penicillin, and close and immobi- 
lize it. Excision of joints in general was not employed, although in rare in- 
stances excision is preferable to amputation. 

Penetrating wounds of the chest with blood or pus in the pleural cavity 
were considered to present a problem similar to that of a wound of a joint. 
These were opened, pus or blood clots were removed, penicillin was placed 
in the cavity, and the wound was closed. The goal to be attained in thoracic 
surgery is expansion of the lung. Aspiration and poor drainage were found 
ineffective. Decortication was essential in some of the longer standing cases 
and properly performed was followed by good results. 



Burned News Letter, Vol. 5, NO. 4 RESTRICTED 



Penetrating wounds of the abdomen with post-traumatic fecal peritonitis 
were treated either with sulfonamides or with penicillin; it seemed that both 
were only minor adjuncts to the surgical measures employed. 

' It is important to try to bring nerve repair into the reparative phase of 
the work at the base hospitals, and it was found possible to do this in a con- 
siderable number of cases. Cranio-cerebral injuries likewise required com- 
plete debridement with removal of all foreign bodies and damaged brain tissue. 
Too frequently it was found that all of the bone fragments had not been removed at 
the initial debridement, and that as a result it was necessary to do a secondary de- 
bridement with removal of fragments at the base hospital and to follow this with 
closure of the wound even in the presence of pus. Such cases were not regarded, 
however, as brain abscesses but rather as a cerebritis with dead tissue. Oc- 
casionally, when there was dead space, temporary drainage was required. 

To summarize: The management of infected wounds in all regions i s 
based upon the conception that dead tissue forms the pabulum for the propa- 
gation of pathogenic organisms, that the varied flora and their functional 
activity depend upon the nature and amount of this pabulum, and that while 
parenteral chemotherapy is helpful it cannot be substituted for good initial 
surgery, the purpose of which is to remove the pabulum upon which the organ- 
isms may develop. (From the Minutes of the Subcommittee of Infected Wounds 
and Burns of the National Research Council, Dec. 8, '44.) 

****** 

■ Medical Field Research Laboratory Accomplishments ; The establishment 
of the Medical Field Research Laboratory at Camp Lejeune was announced in 
the Burned News Letter of April 14 1944. A report of the activities of this 
laboratory for the six-month period ending January 1, 1944, has recently 
been received by the Bureau of Medicine and Surgery, and provides informa- 
tion regarding research completed and being conducted by this activity. 

Items of equipment, which were originally developed at the Medical Field 
Research Laboratory and which have been adopted and are being placed in use 
include (1) an emergency first-aid and blackout tent, (2) a new and more practi- 
cal Hospital Corps pouch, and (3) a nylon cloth litter. (See Burned News Letter 
of Nov. 10, 1944.) 

This Research Laboratory has conducted field tests on a number of products 
and items of equipment developed at the Naval Medical Research Institute. 
Among these are (1) a new impregnated salt tablet which produces less gastric 
irritation than does the standard salt tablet, (2) a sun-protective lipstick, (3) 
new types of adhesive tapes and liquids, and (4) four agents for sterilizing 
water. Field tests have been carried out on gas-proof clothing developed by 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 



the Naval Research Laboratory, and many patch tests have been done with 
respect to possible skin sensitivity of personnel to new materials for clothing 
and compounds designed for the impregnation of clothing. 

The Medical Field Research Laboratory has carried on field tests of a 
new armored utility jacket, similar to the armored life jacket mentioned in 
the Burned News Letter of November 24, 1944. A new type of boot, developed 
by the Army and possessing a nylon top has been tried out. It offers promise 
with regard to increasing the comfort of men exposed to tropical heat and to 
reducing the incidence of fungus infections of the feet. 

A waterproof pack to be used in amphibious landings has been developed 
which can be worn comfortably on the back and in which can be transported 
32 pounds of medical supplies. Studies have been made of possible modifica- 
tions in field X-ray equipment which would reduce the weight of this equipment 
by about 250 pounds and its volume by 19 cubic feet. The new design permits 
packing the X-ray unit together with a blackout tent, a head-type fluoroscope 
and supplies sufficient for 30 days in a case which can be carried in a j e e p 
ambulance. Designs have been drawn up for practical improvements in the 
Field Sick-Call Chest. 

A new coating for waterproofing labels on wood, glass, rubber, metal and 
plastics has been tested under rugged conditions. It may be used as the ad- 
hesive as well as the overcoating of labels. A stable emulsion of dimethyl - 
phthalate has been made for the impregnation of clothing. It is not irritating 
to the skin. Also, a cosmetically-pleasing ointment containing dimethylphtha- 
late has been compounded which promises to be superior in duration of repel - 
lency to those presently in use. 

A pyramidal collapsible water container, originally designed by Lt. Col. 
F. R. Geraci, has been developed into a practical item of field e quipment . 
Other items are a combination tent-mosquito-net unit and an emergency water 
container. The latter is made of light plastic -coated fabric, occupies very 
little space when not filled, has a capacity of 3,800 c.c. of water and will with- 
stand the action of any of the chemicals currently used for the purification of 
water. 

Appraisals have been made of psychological tests for determining the fit- 
ness of officer candidates for their duties. 

* * 

After the completion of field tests, new items of equipment must be ac- 
cepted by the proper authority. Following this , problems of allotment of critical 
materials to manufacturers , as well as production, procurement and delivery 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 



of the items arise. Consequently, many months may elapse between develop- 
ment and actual use in the field. 

sf; 3fr jf: i)c + * 

Assignment of Medical Officers to Duties of Combatant Character : The 
following decision (C.M.O. 92-1918 p. 23), which is quoted in its entirety, will 
be of interest to medical officers: 

"Upon decision requested as to whether or not medical officers can be 
legally assigned to duty as coding' officers, Held: That neither chaplains, 
doctors, nor members of the Hospital Corps should be assigned to duties of 
a combatant character. Such members of the staff personnel of a naval ves- 
sel are neutralized by the terms of the Geneva Convention, the principles of 
which the United States accepts for general guidance. (See paragraph 1, In- 
structions concerning the Disposition of Prisoners of War, etc., approved by 
the State Department, May 7, 1918, and by the Secretary of the Navy, May 9, 1918.) 

"Duty as a coding officer is, in the opinion of the Department, duty of a 
strictly military and combatant character, and no medical officer should be 
required to perform such duty, especially in time of war. 

"It was also pointed out that such duties as are required of members of 
naval courts and boards, while essentially military, are not of a combatant 
nature, and medical officers may be legally assigned to such duties (File 
28578-356, SecNav, July 27, 1918)." 

Article 121, Navy Regulations, reads as follows: 

"Members of the Hospital Corps shall not perform any military duties 
other than those pertaining to the medical department." . 

****** 

Chronic Alcoholism - Time Lost Due to Misconduct : In connection with 
a recent request for a misconduct decision, the Bureau of Medicine and Surgery 
submitted the following questions to the Judge Advocate General: 

"(a) A man is admitted to the sick list with the diagnosis of chronic • 
alcoholism based solely on the history of his case prior to entry into the 
service. 

Question: Should time lost be considered due to misconduct ? 

(b) A man is admitted to the sick list with diagnosis undetermined. After 
two days' observation and study, it is found that this disability is due to the 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



intemperate use of alcoholic liquor or habit-forming drugs and the diagnosis 
is established accordingly. After five days on the sick list he recovers from 
the immediate effect of his intemperance, but in view of his past history he 
is brought before a Board of Medical Survey and found to be unfit for the Service. 
The report of the Board is approved, and the man is discharged from the Service 
after twenty days on the sick list. 

Question: Should this man be charged with misconduct and consequent loss of 
pay for five or twenty days ? 

(c) If the individual's indulgence in alcohol is a symptom of a mental ill- 
ness, is it proper for him to be charged with misconduct when he is admitted 
to the sick list with a diagnosis of chronic alcoholism? (This applies only to 
persons who are considered to be mentally competent and responsible for 
their actions.)" 

The Judge Advocate General's answers to these three questions are quoted 
herewith for the information and guidance of medical officers and other Medi- 
cal Department personnel concerned: 

"(a) Admittance to the sick list with a diagnosis of chronic alcoholism, 
based solely on the history of the case prior to entry into Service, should re- 
sult in loss of pay if the absence from regular duty extended beyond one day. 

(b) The person should lose five days' pay. Retention on the sick list be- 
yond the time when a person is fit for the performance of regular duties and 
which absence occurs by reason of administrative procedure incident to con- 
sideration of and final action on the report of the board of medical survey, is 
not absence from duty on account of the effects of a disease. 

Cc) If the person's indulgence in alcoholic liquor is a symptom of a mental 
illness, and the person is mentally competent, absence from regular duties for 
more than one day at a time with a diagnosis of chronic alcoholism would re- 
sult in loss of pay." 

In cases of absence from duties which are related to alcoholism, pay should 
be checked when the following elements or factors concurrently exist, namely: 

"(1) The absence must be on account of the effects of a disease; (2) the 
disease must be directly attributable to own use of alcoholic liquor; (3) the 
disease must immediately follow such use; and (4) such use of alcoholic liquor 
must be intemperate." (Med. Rec. Div., BuMed - B. E. Irwin) 

3fc % J)c Jft 3^ + 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 



Combat Medical Planning Branch : A Combat Medical. Planning Branch 
has recently been established in the Planning Division, BuMed. This Branch 
is composed of two sections: a Marine Corps Medical Planning Section and 
an Amphibious Combat Medical Planning Section. Capt. French R. Moore 
CMC) , USN, is currently the head of the Branch. The Marine Corps Combat 
Medical Planning Section performs the functions of the Branch as they re- 
late to Marine Corps activities. The medical officer of this section devotes 
his whole time to liaison activities between the Branch and the Marine Corps 
and has his office -at the Marine Corps Headquarters, Arlington Annex, Wash- 
ington, D. C. The Amphibious Combat Medical Planning Section performs the 
functions of the Branch as they relate to Amphibious Combat conditions. The 
medical officer of this section maintains part-time liaison activities with the 
Amphibious Section, Navy Department, and the Operations Division, Office of 
the Surgeon General, U. S. Army. The Hospital Corps officer of this Branch 
maintains part-time liaison with the Development, Organization and Equip- 
ment Allowance and Requirements Branches of the Office of the Surgeon Gen- 
eral, U. S. Army. The Combat Medical Planning Branch is anxious to receive 
from activities in the field and amphibious units recommendations and sug- 
gestions relating to supplies, equipment, development of new field medical 
units, revision of present field medical units, personnel, medical field organi- 
zations, amphibious doctrines and all other matters that come within the 
scope of its activities. (Plan. Div., BuMed - F. R. Moore) 

>|c ♦ + + ' * ♦ 

Erratum: In regard to the item on Plague in the Burned News Letter of 
February 2, 1945, we have been informed by the Division of Preventive Medi- 
cine that immunization against plague should be carried out as follows: 

All Naval and Marine Corps Personnel on active duty in, about to be trans- 
ferred to or traveling in areas where human plague has been endemic in recent 
years and is epidemic at the time should receive plague vaccine. 

Exceptions are those who present acceptable evidence that they have been 
immunized within the preceding four months. 

Notice to Graduates of the Medical College of Virginia. School of Dentistry: 
This school is collecting data concerning all of its graduates who are in the 
Armed Services. All those who have not sent in the questionnaires which were 
mailed to them are requested to advise the Dean as to their date of graduation, 
date of entering Service, present rank and address. The letter should be ad- 
dressed to the Dean, Medical College of Virginia, School of Dentistry, Rich- 
mond 19, Virginia. 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 

Public Health Foreign Reports : 

Disease Place Date Number of Cases 

Plague Algeria, Algiers Nov. 1-10, '44 6 (suspected) 

Fr. West Africa, Dakar Nov. 21-27,. '44 2 (fatal) 

Madagascar Nov. 21-30, '44 12 

Morocco (French) Dec. 1-10, '44 3 . 

Union of South Africa Nov. 11-25, '44 3 

Smallpox Peru Oct. '44 ' 38 

Rhodesia (Northern) Oct. 22-Nov. 18, '44 136 (1 fatal) 

Sierra Leone Sept. 10- Oct. 14, '44 22 (1 fatal) 

Typhus Algeria Nov. 1-10, '44 36 

Fever Hungary Nov. 11-18, '44 9 

Morocco (French) Dec. 1-10, '44 49 

Peru Oct. '44 171 

Rhodesia (Northern) Nov. 11-18, '44 30 

Sierra Leone Oct. 7-14, '44 3 



(Pub. Health Reps., Jan. 5 & 19, '45) 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



To: 



All Ships and Stations. 



BUMED-ECB-FAS 
A3-3/ENlO(064) 



Subj: Modification of Usage in Identifying Medical 

Department Forms and Publications. 14 Dec 1944 

Ends: (A) AstSecNav circ ltr of 22 Apr 1943, Identification of Publications 
and Forms. 

(B) List of Medical Department Forms and Publications (exclusive of 
those used for internal administrative purposes in BuMed) . 

1 . In compliance with enclosure (A) , all official forms and publications of the 
Medical Department shall hereafter be identified as indicated herewith, enclo- 
sure (B), effective this date. All paragraphs in the Manual of the Medical De- 
partment, and previously issued directives in connection with subject, are - 
hereby amended in accordance with the provisions outlined herein. 

2. Identification numbers and letters of all official Medical Department forms 
and publications will be preceded by the designation "NAVMED." Designa- 
tions of all such forms and publications will be made only by BuMed and will 
be entered in a register maintained in BuMed for control purposes. Local or 
internal forms and publications originating within a medical activity will be 
identified by such designations as the commanding officer may determine, bat 
in no case shall the prefix NAVMED be used for such forms or publications. 

--BuMed. Ross T. Mclntire. 



Subj: Identification of publications and forms. 

1. There is at present considerable trouble and confusion caused by the ina- 
bility to identify publications and forms when requests are made for them by 
field activities or the public. In some cases compliance with such requests 
have been considerably delayed in the effort to find out which bureau has cog- 
nizance over the publications or forms requested. 

2. In order to eliminate this difficulty and to help identify printed material 
for quick action on requests, it is necessary that some means of positive 
identification be- adopted for use by all bureaus and offices. 



Enclosure (A) 



From: 
To: 



The Assistant Secretary of the Navy. 
Bureaus, Boards and Offices, Navy Department. 
Headquarters, U. S. Marine Corps. 
Headquarters, U. S. Coast Guard. 



April 22, 1943 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



3. At present most publications and forms bear either a title or a number and 
in many cases both. In the case of publications in the Registered Publications 
System, short titles are now assigned which satisfactorily identify the promul- 
gating bureaus or offices. In the future, all publications exclusive of those in- 
cluded in the Registered Publications System (including books, booklets, manuals 
pamphlets, instruction sheets, etc.) and blank forms (including both printed 

and processed forms) will bear whatever title or number the cognizant bureau 
or office may deem desirable , but in each case the number will be preceded by 
a group of letters indicating first, that the printed piece belongs to the Navy and 
second, the bureau or office which originated it. 

4. These prefixes to the identifying numbers will be as follows: 



Office of the Secretary of the Navy SECNAV 

Executive Office of the Secretary. ..NAVEXOS 

Office of Naval Operations OPNAV 

Bureau of Naval Personnel NAVPERS 

Bureau of Ordnance , NAVORD 

Bureau of Aeronautics .NAVAER 

Bureau of Ships. NAVSHIPS 

Bureau of Supplies and Accounts NAVSANDA 

Bureau of Medicine and Surgery NAVMED 

Bureau of Yards and Docks. ...NAVDOCKS 

Marine Corps NAVMC 

C oast Guard NAVC G 



5. Following the above prefixes each bureau or office may use its own method 
of internal identification. It may be desirable for some of the large bureaus 
and offices to have a further identification breakdown within the unit, although 
additional prefixes or suffixes to the number should be kept to a minimum. 

6. This identification system is particularly important on publications and 
the number should be placed on the cover immediately above or below the 
title in order that persons ordering the publication will order by both title and 
number. 

7. This identification system is a part of the forms and publications control 
program. Further information can be obtained from Lt. Comdr. F. M. Knox, 
Director of Publications, Administrative Office, Executive Office of the Secre- 
tary, Room 1124, telephone 3227. 



RALPH A. BARD 



r r 

Burned News Letter, Vol. 5, No. 4 RESTRICTED 



Enclosure (B) 

LIST OF MEDICAL DEPARTMENT FORMS AND PUBLICATIONS 
(exclusive of those used for internal administrative purposes in BUMed) 



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(Following Sheet) 


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Report of Dental Operations and Treatment 


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Morning Report of Sick 
Report of Pivilian Medical, Dental and 

Hospital Treatment 
Statement of Receipts and Expenditures 

of Medical Stores 
Supplies and Equipment Ledger Sheet 
Land and Building Ledger Sheet 
Recruiting Statistics 
Recruiting File Record 
Report of Physical Examination 
Physical Examination for Flying 
Receipt, Transfer and Status Card 
Roster Report of the Hospital Corps 
Roster Report of the Hospital Corps 

(Following Sheet) 
Admission or Discharge of Officers 
Transfer of Men 
Order to Transfer Accounts 
Order for Transfer of Men 
Order for Transportation 
Ward Report 
Daily Personnel Report 
Equipment Voucher 
Clinical Notes 
Diet Sheet 
Liberty Pass 
Laundry List 
Personal Effects Tag 
Order and Inspection Blank 
Baggage Record Card 
Laboratory Examination 
Pass Book 

Letterheads (U. S. Naval Hospitals) 
Commissary Ledger (Cash Value Sheet) 
Commissary Ledger (Extra Sheet) 
Ration Record 

Receipt and Expenditure Voucher (For 

Commissary Ledger) 
Burial Record 
Register of Patients 
Special Diet Order Sheet 
Information Slip - Navy Nurse Corps 
Notice of Change in Diagnosis 
Special Examination and Treatment Request 



- 27 - 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



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Operation Record 
Clinical Record 

Anatomical Chart for Clinical Record 
Information for Next of Kin 
Time and Pay Roll Record 
Request for Repairs 
Operations Scheduled 
Communications Routing Slip 
Allotment Record 

Requisition and Invoice, Medical Supplies 

and Equipment 
Patient's Identity Tag 
Report of Neuropsychiatric Patients 
Quarterly Report of Patient Bed Capacities 
Weekly Morbidity Report (Publication) 
First Aid for Battle Casualties 
Control of Malaria Vectors 
U. S. Naval Medical Bulletin 
Hospital Corps Quarterly 
Outline of Medical Dept. Duties, U.S. N. 
Supply Catalog. Medical Dept., U.S.N. 
Manual of the Medical Department 
Edible Food Plants, Arctic Region, 1943 
Nurse Corps Application for Appointment 
Student Record in Federal Nursing Services 
Electric Shock, First Aid Treatment ' 
Medical Compend for Comdrs. of Naval 

Vessels 
Manual of Naval Hygiene 
Edible and Poisonous Plants of Caribbean 

Region 

Handbook of the Hospital Corps 
Epidemiology of the Diseases of Military 

Importance in the Netherland Indies, 1943 
Hospital Corpsman, U.S.N. , 1943 
Epidemiological Throat Culture Card 
Research Division Project Form 
Penicillin Therapy Report 
Penicillin Therapy Report (Continuation 

Sheet) 

Prevention of Malaria in Military and Naval 

Forces in the South Pacific 
Military Malaria Control in the Field 
Malaria Mosquitoes and Men 



Burned News Letter, Vol. 5, No. 4 



RESTRICTED 



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SAME 
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NAVMED-217 



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Label Direction, Box, Round 
Label Direction, Poison (bottle and powder 
box) 

Prescription Pads 
Catalog of Medical Teaching Films 
First Aid Treatment for Survivors of 
■ Disasters at Sea 

Statistics of Diseases and Injuries, 1941 
Instructions for Next of Kin 
Venereal Disease Contact Report 
Weekly Morbidity Report (Form) 
Biographical Inventory 
Mechanical Comprehension Test 

(MCT) Form 4 
Mechanical Comprehension Test 

(MCT) Form 5 
Aviation Classification Test - ACT 

Form 1 

Aviation Classification Test - ACT 
Form 2 

Health Precautions for Personnel on 

Detached Duty 
Answer Sheet, ACT, MCT 
Answer Sheet, B.I. 
Mechanical Comprehension Key 

(MCT) Form 4 
Mechanical Comprehension Key 

(MCT) Form 5 
Aviation Classification Key (ACT) 

Form 1 

Aviation Classificaton Key (ACT) 
Form 2 

Biographical Inventory, Key 1 

Biographical Inventory, Key 2 

Biographical Inventory, Key 3 

Emergency Medical Tag 

Compilation on the Diseases of Naval 
Importance of Micronesia 

Index of References to Physical Exami- 
nations, Physical Requirements and 
Physical Standards for U.S. Navy, U.S. 
Naval Reserve, U.S. Marine Corps, and 
U.S. Marine Corps Reserve 

Medical Questionnaire for Applicants for 

the Navy Nurse Corps and Naval Reserve 
Corps 



- 29 - 



r r 

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NAVMED- 232 SAME 
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NAVMED-256 SAME 

NAVMED-259 NAVMED-255-0 

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Manual on Treatment of Casualties from 
Chemical Warfare Agents (for the infor- 
mation and guidance of Medical Officers , 
USN) 

Navy Nurse Corps Uniform Instruction 
Results of Aviation Cadet Selection Tests 
USN Aviation Cadet Selection Tests 

Examiner's Manual 
Medical Stores Invoice (6 part set) 
Medical Stores Invoice (6 part set continu- 
ation) 

Naval Dental Officer Questionnaire 
Medical Stores Invoice (9 part set) 
Medical Stores Invoice (9 part set continu- 
ation) 

Epidemiology of Diseases of Naval 

Importance in Formosa 
The NP Problem 

The Prevention of Bacterial Respiratory 
Tract Infection in the U.S. Navy by 
Sulfadiazine Prophylaxes 

Manual on DDT Insecticides 

Naval Aviation Night Vision Instructor's 
Manual 

Typical Breeding and Resting Places of 
Anopheles Punctulatus Moluccensis in - 
the South Pacific 

Prophylactic Immunizations Required in 
the U.S. Navy 

Chart - "U.S. Naval Medical History" 

Aviation Psychology Technical Memoran- 
dum 

Chapter 11 - Physical Examinations for 

the Medical Dept. 
Chapter 15 - Diagnostic Nomenclature 

for the Medical Dept. 
Chapter 19 - Deaths and Resulting Duties 
Chapter 21 - Medical and Dental Attendance 
Field Photographic Unit - Field Casualty 

Record 

Field Photographic Unit - Evacuation 

Photo Field Casualty 
Field Photographic Unit - Base and Station 

Report 




- 30 - 



Burned News Letter, Vol. 5, No. 4 RESTRICTED 



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-1 


Handbook of the Hospital Corps, Supplement 


NAVMED- 


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-a 


Hospital Corpsman - Procurement Card 


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Malaria Don'ts After Sundown 


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The Mosquito is Little - But 


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Casualty List - Japs 1, Malaria 3 


NAVMED- 


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-d 


Enemies Both' 


NAVMED- 


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NAVMED- 141- 


-e 


Man Made Malaria 


NAVMED- 


■365 


NAVMED-141' 


-f 


Is Your Organization Prepared 


NAVMED- 


■366 


NONE 




Commissioning Outfits for Naval Vessels, 
Medical Dept., USN, Catalog of Tablets 


NAVMED- 


■367 


NONE 




Catalog of Hospital Corps Schools and 
Courses 


NAVMED- 


■368 


NONE 




Drill Book for the Hospital Corps, USN, 
1942 


NAVMED- 

X H X X V J.V1_LJ -J — ' 


■369 


NONE 




News Letter 


NAVMED- 


■370 


NONE 




Aviation Supplement 


NAVMED- 


■371 


NONE 




Medical Services, Joint Overseas Operation 
CRestricted) 


NAVMED- 


■372 


NONE 




Job Analysis, Hospital Corps USN, 1942 


NAVMED- 


■373 


NONE 




Enlist in the WAVES - Serve in the Hospi- 
tal Corps 


NAVMED- 

X ■ X X V 1V1-1— ' J ^ 


■374 


NONE 




The Navy Nurse Corps, 1943 


NAVMED- 

X * X X V 1M1 1 1 .1— -* 


■375 


NONE 




Individual First Aid Packet, 1943 (Poster) 


NAVMED- 

X \ J- X V X V J. 1 1 J — ■* 


■376 


NONE 

J. M v — X v X— 1 




To A Youns 1 Woman Entering - the Navv. 1943 


NAVMED - 


■377 


VD-2 




On Target 


NAVMED- 


■378 


VD-3 




The Story of Old Joe 


NAVMED- 


■379 


VD-4 




Ed Puts 'Em Wise ■ 


NAVMED- 


■380 


VD-5 




Service to Tojo 


NAVMED- 


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VD-6 




Protect Yourself 


NAVMED- 


■382 


VD-7 




Lightning Does Strike Twice 


NAVMED - 


■383 


VD-8 




Hull Down 


NAVMED- 


•384 


VP-1 • 




Venereal Disease, VP-1, 1943, "Fight 
Syphilis' ' 


NAVMED- 


■385 


VP-2 




Venereal Disease, VP-2, 1943, "Easy 
to Get" 


NAVMED- 


■386 


VP-3 




Venereal Disease, VP-3, 1943, "Your 
Face Looks So Familiar" 


NAVMED- 


■387 


VP -4 




Venereal Disease. VP -4. 1943. "Them 
Days is Gone Forever" (Sailors) 


NAVMED - 


■388 


VP-5 




Venereal Disease, VP-5, 1943, "Them 
Days is Gone Forever" (Marines) 


NAVMED- 


■389 


VP-6 




Venereal Disease, VP-6, 1944, "It's 
Worth Repeating" 


NAVMED- 


•390 


VP-7 




Venereal Disease, VP-7, 1944, "Please 
Be Careful" 



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^med News Letter, Vol. 5, No. 



RESTRICTED 



NAVMED 


-391 


VP-8 


Venereal Disease, VP-8, 1944, "Now 
What Was I Supposed to Remember" 


NAVMED 


-392 


VP- 9 


Venereal Disease, VP-9, 1944, ' Pro 
Station 30 Feet" 


NAVMED 


-393 


VP-IO 


Venereal Disease, VP -10, 1944, 4 'Liberty- 
Pass " 


NAVMED 


-394 


VP-ll 


Venereal Disease, VP-ll, 1944, "Let 
There Be Light" 


NAVMED 


-397 


VP- 1 2 


Venereal Disease, VP-12, 1944, "There's 
No Place" 


NAVMED- 


rinn 

-398 


VP-13 


Venereal Disease, VP-13, 1944, "I Should 
Have Gone to the Pro Station" 


NAVMED- 


-399 


VP- 14 


Venereal Disease, VP-14, 1944, "Lightning 
Can Strike Twice 


NAVMED- 


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Hospital Ticket - Women 


NAVMED- 


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SAME 


Facts About the Navy Nurse Corps 


NAVMED- 


-426 


SAME 


Instructions to Applicants for Commission 
in the Nurse Corps and Reserve Nurse 














Corps, USN (Part 1-A) 


NAVMED- 


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SAME 


Instructions to Applicants for Commission 
in the Nurse Corps and Reserve Nurse 
Corps, USN (Part 1-B) 


NAVMED - 


-428 


SAME 


Instructions to Applicants for Commission 
in the Nurse Corps and Reserve Nurse 
Corps, USN (Part 2) 


NAVMED- 


■429 


SAME 


Information for Applicants for Commission 
in the Nurse Corps and Reserve Nurse 
Corps, USN 


NAVMED- 


■439 


SAME 


Low Pressure Chamber Flight Log 


NAVMED- 


■440 


SAME 


Altitude Training Unit Monthly Report 


NAVMED- 


•451 


SAME 


List of Publications 


NAVMED- 


■460 


SAME 


Supplement to the Epidemiology of Diseases 
of Naval Importance -in Formosa 


NAVMED- 


•461 


SAME 


Quarterly Dental Report - Personnel 


NAVMED- 


518 


SAME 


Manual on Rat Control 


NAVMED- 


539 


SAME 


Supplement to Examiner s Medical Manual 
(Aviation) 


NAVMED - 


546 


SAME 


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Directory of Officers of BuMed 


NAVMED- 


556 


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Spectacle Order 


NAVMED- 


566 


NONE 


Appointment Book, Medical Dept. 


NAVMED - 


do / 


NONE 


Register Number 1 - Charge Register 


JNAVJVLiljiJ- 


Rfift 
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Register 


NAVMED- 


569 


NONE 


Register Number 3 - Recapitulation of 
Ledger Accounts 


NAVMED- 


570 


NONE 


Sheets, Ruled (For General Ledger) 


NAVMED- 


574 


NAVMED 4TR 


Medical Stores Requisition (Transferred) 



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